Congressional Record, Volume 142 Issue 114 (Tuesday, July 30, 1996)

[Congressional Record Volume 142, Number 114 (Tuesday, July 30, 1996)]
[House]
[Pages H8768-H8776]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

VETERANS' HEALTH CARE ELIGIBILITY REFORM ACT OF 1996

Mr. STUMP. Mr. Speaker, I move to suspend the rules and pass the bill
(H.R. 3118) to amend title 38, United States Code, to reform
eligibility for health care provided by the Department of Veterans
Affairs, as amended.
The Clerk read as follows:

H.R. 3118

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; REFERENCES TO TITLE 38, UNITED STATES
CODE.

(a) Short Title.--This Act may be cited as the ``Veterans'
Health Care Eligibility Reform Act of 1996''.
(b) References to Title 38, United States Code.--Except as
otherwise expressly provided, whenever in this Act an
amendment or repeal is expressed in terms of an amendment to,
or repeal of, a section or other provision, the reference
shall be considered to be made to a section or other
provision of title 38, United States Code.

SEC. 2. HOSPITAL CARE AND MEDICAL SERVICES.

(a) Eligibility for Care.--Section 1710(a) is amended by
striking out paragraphs (1) and (2) and inserting the
following:
``(a)(1) The Secretary shall, to the extent and in the
amount provided in advance in appropriations Acts for these
purposes, provide hospital care and medical services, and may
provide nursing home care, which the Secretary determines is
needed to any veteran--
``(A) with a compensable service-connected disability;
``(B) whose discharge or release from active military,
naval, or air service was for a compensable disability that
was incurred or aggravated in the line of duty;
``(C) who is in receipt of, or who, but for a suspension
pursuant to section 1151 of this title (or both a suspension
and the receipt of retired pay), would be entitled to
disability compensation, but only to the extent that such
veteran's continuing eligibility for such care is provided
for in the judgment or settlement provided for in such
section;
``(D) who is a former prisoner of war;
``(E) of the Mexican border period or of World War I;
``(F) who was exposed to a toxic substance, radiation, or
environmental hazard, as provided in subsection (e); and
``(G) who is unable to defray the expenses of necessary
care as determined under section 1722(a) of this title.
``(2) In the case of a veteran who is not described in
paragraph (1), the Secretary may, to the extent resources and
facilities are available and subject to the provisions of
subsection (f), furnish hospital care, medical services, and
nursing home care which the Secretary determines is
needed.''.
(b) Conforming Amendments.--(1) Section 1710(e) is
amended--
(A) in paragraph (1), by striking out ``hospital care and
nursing home care'' in subparagraphs (A), (B), and (C) and
inserting in lieu thereof ``hospital care, medical services,
and nursing home care'';
(B) in paragraph (2), by inserting ``and medical services''
after ``Hospital and nursing home care''; and
(C) by striking out ``subsection (a)(1)(G) of this
section'' each place it appears and inserting in lieu thereof
``subsection (a)(1)(F)''.
(2) Chapter 17 is amended--
(A) by redesignating subsection (g) of section 1710 as
subsection (h); and
(B) by transferring subsection (f) of section 1712 to
section 1710 so as to appear after subsection (f),
redesignating such subsection as subsection (g), and amending
such subsection by striking out ``section 1710(a)(2) of this
title'' in paragraph (1) and inserting in lieu thereof
``subsection (a)(2) of this section''.
(3) Section 1712 is amended--
(A) by striking out subsections (a) and (i); and
(B) by redesignating subsections (b), (c), (d), (h) and
(j), as subsections (a), (b), (c), (d), and (e),
respectively.

SEC. 3. PROSTHETICS.

(a) Eligibility for Prosthetics.--Section 1701(6)(A)(i) is
amended--
(1) by striking out ``(in the case of a person otherwise
receiving care or services under this chapter)'' and
``(except under the conditions described in section
1712(a)(5)(A) of this title),'';
(2) by inserting ``(in the case of a person otherwise
receiving care or services under this chapter)'' before
``wheelchairs,''; and
(3) by inserting ``except that the Secretary may not
furnish sensori-neural aids other than in accordance with
guidelines which the Secretary shall prescribe,'' after
``reasonable and necessary,''.
(b) Regulations.--Not later than 30 days after the date of
the enactment of this Act, the Secretary of Veterans Affairs
shall prescribe the guidelines required by the amendments
made by subsection (a) and shall furnish a copy of those
guidelines to the Committees on Veterans' Affairs of the
Senate and House of Representatives.

SEC. 4. MANAGEMENT OF HEALTH CARE.

(a) In General.--(1) Chapter 17 is amended by inserting
after section 1704 the following new sections:

``Sec. 1705. Management of health care: patient enrollment
system

``(a) In managing the provision of hospital care and
medical services under section 1710(a)(1) of this title, the
Secretary, in accordance with regulations the Secretary shall
prescribe, shall establish and operate a system of annual
patient enrollment. The Secretary shall manage the enrollment
of veterans in accordance with the following priorities, in
the order listed:
``(1) Veterans with service-connected disabilities rated 30
percent or greater.
``(2) Veterans who are former prisoners of war and veterans
with service-connected disabilities rated 10 percent or 20
percent.
``(3) Veterans who are in receipt of increased pension
based on a need of regular aid and attendance or by reason of
being permanently housebound and other veterans who are
catastrophically disabled.
``(4) Veterans not covered by paragraphs (1) through (3)
who are unable to defray the expenses of necessary care as
determined under section 1722(a) of this title.
``(5) All other veterans eligible for hospital care,
medical services, and nursing home care under section
1710(a)(1) of this title.
``(b) In the design of an enrollment system under
subsection (a), the Secretary--
``(1) shall ensure that the system will be managed in a
manner to ensure that the provision of care to enrollees is
timely and acceptable in quality;
``(2) may establish additional priorities within each
priority group specified in subsection (a), as the Secretary
determines necessary; and
``(3) may provide for exceptions to the specified
priorities where dictated by compelling medical reasons.

``Sec. 1706. Management of health care: other requirements

``(a) In managing the provision of hospital care and
medical services under section 1710(a) of this title, the
Secretary shall, to the extent feasible, design, establish
and manage health care programs in such a manner as to
promote cost-effective delivery of health care services in
the most clinically appropriate setting.
``(b) In managing the provision of hospital care and
medical services under section 1710(a) of this title, the
Secretary--
``(1) may contract for hospital care and medical services
when Department facilities are not capable of furnishing such
care and services economically, and

[[Page H8769]]

``(2) shall make such rules and regulations regarding
acquisition procedures or policies as the Secretary considers
appropriate to provide such needed care and services.
``(c) In managing the provision of hospital care and
medical services under section 1710(a) of this title, the
Secretary shall ensure that the Department maintains its
capacity to provide for the specialized treatment and
rehabilitative needs of disabled veterans described in
section 1710(a) of this title (including veterans with spinal
cord dysfunction, blindness, amputations, and mental illness)
within distinct programs or facilities of the Department that
are dedicated to the specialized needs of those veterans in a
manner that (1) affords those veterans reasonable access to
care and services for those specialized needs, and (2)
ensures that overall capacity of the Department to provide
such services is not reduced below the capacity of the
Department, nationwide, to provide those services, as of the
date of the enactment of this section.
``(d) In managing the provision of hospital care and
medical services under section 1710(a) of this title, the
Secretary shall ensure that any veteran with a service-
connected disability is provided all benefits under this
chapter for which that veteran was eligible before the date
of the enactment of this section.''.
(2) The table of sections at the beginning of chapter 17 is
amended by inserting after the item relating to section 1704
the following new items:

``1705. Management of health care: patient enrollment system.
``1706. Management of health care: other requirements.''.

(b) Conforming Amendments to Section 1703.--(1) Section
1703 is amended--
(A) by striking out subsections (a) and (b); and
(B) in subsection (c) by--
(i) striking out ``(c)'', and
(ii) striking out ``this section, sections'' and inserting
in lieu thereof ``sections 1710,''.
(2)(A) The heading of such section is amended to read as
follows:

``Sec. 1703. Annual report on furnishing of care and services
by contract''.

(B) The item relating to such section in the table of
sections at the beginning of chapter 17 is amended to read as
follows:

``1703. Annual report on furnishing of care and services by
contract.''.

SEC. 5. IMPROVED EFFICIENCY IN HEALTH CARE RESOURCE
MANAGEMENT.

(a) Repeal of Sunset Provision.--Section 204 of the
Veterans Health Care Act of 1992 (Public Law 102-585; 106
Stat. 4950) is repealed.
(b) Cost Recovery.--Title II of such Act is further amended
by adding at the end the following new section:

``SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.

``(a) Right To Recover.--In the case of a primary
beneficiary (as described in section 201(2)(B)) who has
coverage under a health-plan contract, as defined in section
1729(i)(1)(A) of title 38, United States Code, and who is
furnished care or services by a Department medical facility
pursuant to this title, the United States shall have the
right to recover or collect charges for such care or services
from such health-plan contract to the extent that the
beneficiary (or the provider of the care or services) would
be eligible to receive payment for such care or services from
such health-plan contract if the care or services had not
been furnished by a department or agency of the United
States. Any funds received from such health-plan contract
shall be credited to funds that have been allotted to the
facility that furnished the care or services.
``(b) Enforcement.--The right of the United States to
recover under such a beneficiary's health-plan contract shall
be enforceable in the same manner as that provided by
subsections (a)(3), (b), (c)(1), (d), (f), (h), and (i) of
section 1729 of title 38, United States Code.''.

SEC. 6. SHARING AGREEMENTS FOR HEALTH CARE RESOURCES.

(a) Repeal of Section 8151.--(1) Subchapter IV of chapter
81 is amended--
(A) by striking out section 8151; and
(B) by redesignating sections 8152, 8153, 8154, 8155, 8156,
8157, and 8158 as sections 8151, 8152, 8153, 8154, 8155,
8156, and 8157, respectively.
(2) The table of sections at the beginning of such chapter
is amended--
(A) by striking out the item relating to section 8151; and
(B) by revising the items relating to sections 8152, 8153,
8154, 8155, 8156, 8157, and 8158 to reflect the
redesignations by paragraph (1)(B).
(b) Revised Authority for Sharing Agreements.--Section 8152
(as redesignated by subsection (a)(1)(B)) is amended--
(1) in subsection (a)(1)(A)--
(A) by striking out ``specialized medical resources'' and
inserting in lieu thereof ``health-care resources''; and
(B) by striking out ``other'' and all that follows through
``medical schools'' and inserting in lieu thereof ``any
medical school, health-care provider, health-care plan,
insurer, or other entity or individual'';
(2) in subsection (a)(2) by striking out ``only'' and all
that follows through ``are not'' and inserting in lieu
thereof ``if such resources are not, or would not be,'';
(3) in subsection (b), by striking out ``reciprocal
reimbursement'' in the first sentence and all that follows
through the period at the end of that sentence and inserting
in lieu thereof ``payment to the Department in accordance
with procedures that provide appropriate flexibility to
negotiate payment which is in the best interest of the
Government.'';
(4) in subsection (d), by striking out ``preclude such
payment, in accordance with--'' and all that follows through
``to such facility therefor'' and inserting in lieu thereof
``preclude such payment to such facility for such care or
services'';
(5) by redesignating subsection (e) as subsection (f); and
(6) by inserting after subsection (d) the following new
subsection (e):
``(e) The Secretary may make an arrangement that authorizes
the furnishing of services by the Secretary under this
section to individuals who are not veterans only if the
Secretary determines--
``(1) that such an arrangement will not result in the
denial of, or a delay in providing access to, care to any
veteran at that facility; and
``(2) that such an arrangement--
``(A) is necessary to maintain an acceptable level and
quality of service to veterans at that facility; or
``(B) will result in the improvement of services to
eligible veterans at that facility.''.
(c) Cross-Reference Amendments.--(1) Section 8110(c)(3)(A)
is amended by striking out ``8153'' and inserting in lieu
thereof ``8152''.
(2) Subsection (b) of section 8154 (as redesignated by
subsection (a)(1)(B)) is amended by striking out ``section
8154'' and inserting in lieu thereof ``section 8153''.
(3) Section 8156 (as redesignated by subsection (a)(1)(B))
is amended--
(A) in subsection (a), by striking out ``section 8153(a)''
and inserting in lieu thereof ``section 8152(a)''; and
(B) in subsection (b)(3), by striking out ``section 8153''
and inserting in lieu thereof ``section 8152''.
(4) Subsection (a) of section 8157 (as redesignated by
subsection (a)(1)(B)) is amended--
(A) in the matter preceding paragraph (1), by striking out
``section 8157'' and ``section 8153(a)'' and inserting in
lieu thereof ``section 8156'' and ``section 8152(a)'',
respectively; and
(B) in paragraph (1), by striking out ``section
8157(b)(4)'' and inserting in lieu thereof ``section
8156(b)(4)''.

SEC. 7. PERSONNEL FURNISHING SHARED RESOURCES.

Section 712(b)(2) is amended--
(1) by striking out ``the sum of--'' and inserting in lieu
thereof ``the sum of the following:'';
(2) by capitalizing the first letter of the first word of
each of subparagraphs (A) and (B);
(3) by striking out ``; and'' at the end of subparagraph
(A) and inserting in lieu thereof a period; and
(4) by adding at the end the following:
``(C) The number of such positions in the Department during
that fiscal year held by persons involved in providing
health-care resources under section 8111 or 8152 of this
title.''.

SEC. 8. AUTHORIZATION OF APPROPRIATIONS.

There is authorized to be appropriated for the Department
of Veterans Affairs for the Medical Care account, for the
purposes specified for that account in Public Law 103-327
(108 Stat. 2300), including the cost of providing hospital
care and medical services under the amendments made by
section 2, not to exceed $17,250,000,000 for fiscal year 1997
and not to exceed $17,900,000,000 for fiscal year 1998.

SEC. 9. REPORT ON IMPLEMENTATION AND OPERATION.

(a) Report Required.--In carrying out sections 2, 3, and 4
(including the amendments made by those sections), the
Secretary of Veterans Affairs shall establish information
systems to assess, and, not later than March 1, 1998, shall
submit to the Committees on Veterans' Affairs of the Senate
and House of Representatives, a report reflecting the
experience of the Department during fiscal year 1997 on--
(1) the effect of implementation of, and provision and
management of care under, sections 2, 3, and 4, on demand for
health care services from the Department of Veterans Affairs
by veterans described in section 1710(a)(1), as amended by
section 2;
(2) any differing patterns of demand on the part of such
veterans relating to such factors as relative distance from
Department facilities and prior experience, or lack of
experience, as recipients of care from the Department;
(3) the extent to which the Department has met such demand
for care; and
(4) changes in health-care delivery patterns in Department
facilities and the fiscal impact of such changes.
(b) Matters To Be Included.--The report under subsection
(a) shall include detailed information with respect to fiscal
year 1997 regarding the following:
(1) The number of veterans enrolled for care at each
Department medical facility and, of those veterans, the
number enrolled at each such facility who had not received
care from the Department during the preceding three fiscal
years.
(2) With respect to those veterans who had not received
care from the Department during the three preceding fiscal
years, the total cost of providing care to those veterans,
shown in total and separately (A) by level of care, and (B)
by reference to whether care is

[[Page H8770]]

furnished in Department facilities or under contract
arrangements.
(3) With respect to the number of veterans described in
section 1710(a)(1), as amended by this Act, who applied for
health care from the Department during fiscal year 1997--
(A) the number who applied for care (shown in total and
separately by facility);
(B) the number who were denied enrollment (shown in total
and separately by facility); and
(C) the number who were denied care which was considered to
be medically necessary but not of an emergency nature (shown
in total and separately by facility).
(4)(A) The numbers and characteristics of, and the type and
extent of health care furnished to, veterans enrolled for
care (shown in total and separately by facility).
(B) The numbers and characteristics of, and the type and
extent of health care furnished to, veterans not enrolled for
care (shown separately by reference to each class of
eligibility, both in total and separately by facility.
(5) The specific fiscal impact (shown in total and by
geographic health-care delivery areas) of changes in delivery
patterns instituted under the amendments made by this Act.

The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Arizona [Mr. Stump] and the gentleman from Mississippi [Mr. Montgomery]
each will control 20 minutes.
The Chair recognizes the gentleman from Arizona [Mr. Stump].

general leave

Mr. STUMP. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days within which to revise and extend their remarks
and include extraneous material on this bill.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Arizona?
There was no objection.
Mr. STUMP. Mr. Speaker, I yield myself such time as I may consume.
(Mr. STUMP asked and was given permission to revise and extend his
remarks.)
Mr. STUMP. Mr. Speaker, H.R. 3118, the Veterans' Health Care
Eligibility Reform Act of 1996, is hopefully the first step toward
overhauling the confusing eligibility requirements currently
confronting our veterans. This bipartisan legislation will move the VA
away from its expensive focus on inpatient care to a more accessible
and cost effective primary and outpatient means of delivering health
care. Eligibility reform has been the top priority of the Committee on
Veterans' Affairs in the 104th Congress. We have worked very hard to
make this bill as budget neutral as possible.

{time} 1330

The VA committee, as well as the Department of Veterans Affairs,
believes the bill can be implemented without the need for additional
funds. However, the Congressional Budget Office disagrees and estimates
that if fully funded, H.R. 3118 would result in increased demand for VA
health care.
Mr. Speaker, the bill is already subject to annual appropriations
since the VA health care is a discretionary spending program. In order
to further address CBO estimates and assure members of the Committee on
Veterans' Affairs budget-neutral intent, we are adding provisions that
will place a ceiling on authorized levels for VA health care for fiscal
years 1997 and 1998.
Mr. Speaker, I want to thank the leadership and particularly the
gentleman from New York [Mr. Solomon], the chairman of the Committee on
Rules, the gentleman from Ohio [Mr. Kasich], chairman of the Committee
on the Budget, for their assistance in getting this bill to the floor
today.
Mr. Speaker, H.R. 3118 may be the final bill brought to the floor of
the House by the Committee on Veterans' Affairs during the 104th
Congress. I must take just a moment to express my deep appreciation and
sincere thanks to my good friend, the gentleman from Mississippi, Sonny
Montgomery, the ranking member of the full committee for his work on
this committee and on this measure.
Mr. Speaker, without the leadership of Sonny Montgomery on veterans
issues over the past 30 years, this country would not have fulfilled
its obligations to our veterans of military service the way they have.
The commitment and dedication of Mr. Montgomery to the men and women
serving in our armed services has rightfully earned him the title ``Mr.
Veteran''.
The members of the Committee on National Security and the Committee
on Veterans' Affairs will miss him energetic support for those
individuals wearing our country's uniforms and for those who have worn
it. I will personally miss his friendship and counsel over the many
years that we have served together in this body. We wish this great
legislator well in all his future endeavors.
Mr. Speaker, I reserve the balance of my time.
Mr. MONTGOMERY. Mr. Speaker, I yield myself such time as I may
consume.
I certainly want to thank my chairman, the gentleman from Arizona,
Bob Stump, for those very kind and warm words. We have had a wonderful
working relationship and great friendship. To Bob Stump and to the
whole committee, we have been nonpartisan, and we are very proud of
that, Mr. Speaker. Our bottom line is to help the veterans, and Bob
Stump has been right there with us all the way, and I thank him again
for those very, very kind remarks, and I hope that they will remember
us some 4 or 5 years from now when we are out somewhere else.
Mr. Speaker, representatives of the major national veterans
organizations have told us that their top legislative priority is
enactment of legislation to reform the VA health care eligibility
rules. Working on a bipartisan basis, we have put a lot of effort into
this, Mr. Speaker, and I congratulate, again, the chairman, Mr. Stump,
on bringing an excellent bill to the floor, H.R. 3138. It has been
endorsed by virtually all the major veterans organizations.
We know that the reforms the veterans' groups had proposed would go
further than we do today, but they do agree that this bill is a big
step forward.
I wish, Mr. Speaker, we could do more, but some other committees of
the House could object and we need to get what we can on eligibility
out for the veterans.
My good friend and our chairman, Bob Stump, as well as the gentleman
from Arkansas, Tim Hutchinson, the chairman of the Subcommittee on
Hospitals and Health Care, and the gentleman from Texas, Chet Edwards,
the subcommittee's ranking member, have really put a lot of time into
developing this important bill and ensuring that it met the concerns of
the veterans.
Our committee's work on eligibility reform actually started before
the 104th Congress, and I particularly want to acknowledge the
outstanding oversight work on this subject done by my very able
colleague, the gentleman from Illinois, Lane Evans, who chaired our
former Subcommittee on Oversight and Investigations.
Mr. Speaker, this bill would reform outdated eligibility laws that
would make it easier to go to outpatient clinics and take care of these
veterans at less cost and more veterans would be eligible to use our
medical facilities. It would simplify rules which are so complex that
even the VA doctors are often confused over who is eligible for what.
It would give VA for the first time clear authority to plan for and
provide treatment to veterans based simply on meeting their medical
needs.
This legislation, Mr. Speaker, also has the support of the Department
of Veterans Affairs, which recognizes the need for change and has urged
us to give them the authority to improve the way they do business. I
think this bill would give VA important tools to provide the kind of
care we owe our veterans and to do it in an efficient and effective
manner.
Mr. Speaker, In adopting eligibility reform legislation, we are
remedying longstanding problems and addressing a long-sought need for
change. In pursuing eligibility reform as a goal, however, some have
had very lofty expectations of what such reform would achieve. Such
high expectations have led some advocates to blur the distinction
between eligibility reform and funding reform. H.R. 3118 does not
attempt to change the manner in which VA medical care is funded. In
contrast, committee amendments to H.R. 3600, 103d Congress, the
President's national health care reform bill, would have converted
funding for VA health care from discretionary to mandatory funding.
H.R. 3118's more modest target does not reflect, on this Member's part,
a belief that those broader objectives should be abandoned.
H.R. 3118 has, however, sparked isolated criticism, largely related
to what it does not attempt to do. Those criticism warrant
acknowledgment.
The most common criticism of this legislation has focused on language
which, in

[[Page H8771]]

amending section 1710(a) of title 38, U.S. Code, qualifies the VA's
obligation to provide hospital care and medical services, stating that
VA shall provide care ``to the extent and in the amount provided in
advance in appropriations Acts for these purposes.'' In essence this
language limits VA medical care spending under the bill to the
availability of appropriations. VA health care, however, is currently
subject to appropriations; this language does not change that fact.
H.R. 3118 aims to improve statutory eligibility rules which have been
attacked for years as badly in need of reform. Under those rules, for
example, most nonservice-connected veterans are not even eligible for
routine outpatient treatment and generally are eligible for home health
care or prosthetics only if they have been hospitalized. This bill
would remedy these and other barriers to VA's providing medically
needed care. The bill's supporters including most veterans
organizations, have described H.R. 3118 as an important step forward,
but the bill has never been represented as a solution to all the
challenges facing VA. For those of us who believe that the wisest
legislative strategy is to make as much progress as you can, when you
can, achieving substantial, positive reform of VA health care
eligibility laws is a good first step.
With respect to funding, the bill has been attacked on the basis that
if funding levels are not sufficient, veterans will be denied care.
Unfortunately, inadequate funding levels would have that same effect
whether or not H.R. 3118 were enacted, just as they have had in the
past.
One critic has expressed concerns that veterans would lose access to
VA care by virtue of a provision of the bill requiring establishment
and implementation of an enrollment system. In fact, the bill does not
specify how that system must work, but allows VA to design a workable
system. That system should enhance VA's ability to plan for and
effectively serve patients, while providing sufficient flexibility so
as not to disenfranchise its most vulnerable and needy veterans. The
report on the bill clarifies that the provision is flexible and would
allow VA ``to establish an enrollment system which simply registers
patients throughout all or part of a fiscal year.'' In fact, the aim of
this legislation is to improve veterans' access to VA care. Its
drafting reflects an understanding that VA is very much a safety net,
serving, for example, a substantial population of veterans with serious
mental illness. The bill does not envision that such veterans can
necessarily be expected to respond to requests to enroll for care
within a time-limited registration period; the drafting of the bill
assumes that an enrollment system would be designed, whether through
provision for exceptions or otherwise, with such patients in mind.

Finally, the bill has also sparked criticism based on a view that the
priorities for enrollment reflected in the legislation are inequitable
and unacceptable because 10 and 20 percent service-connected veterans
are not included in the highest priority classification. This view
fails to take account of the fact that under existing law--38 U.S.C.
section 1712(i)--less than 30 percent service-connected veterans have
been second in line for care since 1988, when Congress moved them up
from third in line in a statutory treatment priority system, where they
had been since 1976.
Overall, the voices of criticism have been very few, and have been
overwhelmingly drowned out by those in support. It is important,
nevertheless, to set the record straight. In short, Mr. Speaker, this
is an excellent bill.
Mr. Speaker, I include for the Record a letter dated July 26, 1996,
from an organization entitled the Independent Budget.

The Independent Budget,

Washington, DC, July 26, 1996.
Hon. G.V. Montgomery,
House of Representatives, Rayburn House Office Bldg.,
Washington, DC.
Dear Representative Montgomery: We are writing to request
your strong support for H.R. 3118, ``The Veterans' Health
Care Eligibility Reform Act of 1996.'' The bill is scheduled
to be brought to the House Floor on Tuesday, July 30, 1996.
Our organizations represent the authors and endorsers of
``The Independent Budget'', an annual review of budget and
policy matters affecting the benefits and services of the
Department of Veterans Affairs. Reforming the VA health care
system's arcane and inefficient eligibility rules has been a
top priority of our organizations for many years.
Current VA eligibility rules dictate what type of services
a veteran will receive based on an overly complex system of
categorical classifications, such as degree of disability,
income, or type of veteran service or status. These
eligibility rules give little regard to what would be the
best, the most cost effective or the most appropriate venue
required to provide the full range of health services a
veteran needs. Such disjointed services are both inconvenient
and unwarrantedly expensive.
The reforms provided for in H.R. 3118, would, for the first
time, give VA health care providers the ability to provide
the full range of appropriate health care services to
eligible veterans utilizing the most cost effective and
efficient methods of modern medical practice.
We consider passage of H.R. 3118 to be one of our highest
priorities for the 104th Congress.
Thank you for your consideration.
Sincerely,
Kenneth E. Wofford, National Commander, AMVETS; Thomas A.
McMasters III, National Commander, Disabled American
Veterans; Carroll M. Fyffe, National Commander,
Military Order of the Purple Heart; Richard Grant,
National President, Paralyzed Veterans of America;
James L. Brazee, Jr., National President, Vietnam
Veterans of America, Inc.; Richard G. Fazakerley, Maj.
Gen. (Ret.), National President, Blinded Veterans
Association; Neil Goldman, National Commander, Jewish
War Veterans of the USA; Charles R. Jackson, President,
Non Commissioned Officers Association; Paul A. Spera,
Commander-in-Chief, Veterans of Foreign Wars of the
United States.

Mr. Speaker, I reserve the balance of my time.
Mr. STUMP. Mr. Speaker, I yield myself such time as I may consume to
also thank the gentleman from Arkansas, Tim Hutchinson, Chairman of the
Subcommittee on Hospitals and Health Care, and the gentleman from
Texas, Chet Edwards, the ranking member on that subcommittee, for all
their hard work not only on this bill, but for both their cooperation
and hard work for carrying the major loads for this committee for this
year.
Mr. Speaker, I yield such time as he may consume to the gentleman
from Arkansas [Mr. Hutchinson].
Mr. HUTCHINSON. Mr. Speaker, I thank the chairman for yielding me
this time, and I want to join the chairman in expressing, once again,
to the gentleman from Mississippi, Sonny Montgomery, how much he will
be missed in this Chamber and in this House. This is the last bill that
the committee will bring to the floor this year and it is an
appropriate time.
My predecessor, John Paul Hammerschmidt, regarded no one higher and
no one closer to him during his 26 years of service in the House than
his relationship with Sonny Montgomery. He would come back to Arkansas
many times and lauding the achievements of Chairman Montgomery and his
advocacy on behalf of veterans. All I can say today is, the half was
not told.
I have enjoyed the last 4 years getting to know the gentleman and I
wish to tell him he certainly will be missed.
Mr. Speaker, today is indeed a historic day for America's veterans,
for it marks the end of a 10-year quest to streamline eligibility for
veterans' health care. Under the leadership of Chairman Bob Stump and
in the true spirit of bipartisanship demonstrated by the ranking
members of the full committee and subcommittee, Sonny Montgomery and
Chet Edwards, the Veterans' Affairs Committee has taken the first major
step to move the delivery of veterans' health care into the 21st
century.
The Veterans' Health Care Eligibility Reform Act of 1996, while not
the panacea for all the ills of VA health care, is the first step in
the rational transformation of the arcane eligibility provisions which
have literally crippled the delivery of VA health services and have
left patients feeling cheated and confused. The bill substitutes a
single, streamlined eligibility provision--based on clinical need for
care--for the complex array of disparate rules currently governing
eligibility for hospital and outpatient care. In doing so, it would
lift restrictions on VA's providing ambulatory treatment. Those
restrictions currently tie many veterans' eligibility for outpatient
treatment to determinations that are medically uninterpretable such as
``to obviate the need for hospital admission.'' The application of
these medically indefinable standards have contributed to relative
disparities in different areas of the country as veterans attempted to
access VA health care.
Understanding that this bill is the first of many steps to come in
improving veterans' health care, it also contains a number of other
important provisions. The bill eliminates restrictions on prosthetic
devices but does not turn VA into a drugstore for such devices as
hearing aids and eyeglasses. It requires VA to manage the provision of
hospital care and medical services through an enrollment system
according to a series of priorities. The bill refocuses our

[[Page H8772]]

time-honored commitment to service-connected care while allowing the VA
to manage care for those veterans with lesser means who depend upon the
VA as their health care safety net.
Other important provisions expand operational flexibility by enabling
the VA to contract for hospital care and medical services to increase
the cost-effective provision of care and services. The bill expands
VA's authority to execute sharing agreements by permitting any medical
resource to be provided under a contractual agreement with any entity.
It also authorizes flexibility in the establishment of payment levels
and exempts the personnel involved in providing services under such
arrangements from personnel hiring limits. This exemption should be
very helpful as VA seeks to participate to a greater extent with
TRICARE and other managed care programs.
An important consideration of this bill is that it offers protection
of specialized services by directing the VA to maintain its capacity to
provide for the specialized treatment and rehabilitation of disabled
veterans within distinct programs and facilities dedicated to the
specialized needs of veterans.
In closing I would like to address the controversial cost estimate
placed on this bill by the Congressional Budget Office, an estimate
that we have strongly refuted with a committee cost estimate. To
further ensure budget neutrality of the bill, it has been amended to
include not only subject to appropriations language but a 2-year cap on
the authorization for the medical care appropriation.
Eligibility reform, in my view, is as significant a piece of
legislation as the G.I. bill. I urge my colleagues to show their
support of veterans by supporting H.R. 3118, the Veterans' Health Care
Eligibility Reform Act of 1996.
Mr. MONTGOMERY. Mr. Speaker, I yield myself such time as I may
consume to thank the gentleman from Arkansas, Tim Hutchinson, for his
very, very kind remarks. We have certainly enjoyed having him in the 4
years he has been on our committee. I would ask him to please tell John
Paul Hammerschmidt I said hello.
Mr. Speaker, I yield such time as he may consume to the distinguished
gentleman from Texas, Mr. Chet Edwards.
Mr. EDWARDS. Mr. Speaker, because of our Nation's veterans, America
won the cold war; because of our Nation's veterans, today we are the
superpower in the world; and because of them our children today live in
a safer world. This bill, H.R. 3118, is an effort, a simple but
important one, to say thank you to those men and women who have served
our Nation in uniform and now need service in our Nation's Va
hospitals.
This bill is a win-win. It is a win for veterans who will receive
better care because of this legislation, and it is a win for our
Nation's taxpayers because it will see that their limited resources are
used more efficiently and effectively on behalf of our Nation's
veterans.
Basically, this bill does two things. It simplifies rules for VA
health care, eligibility rules that perhaps are as complicated as the
IRS Tax Code. By simplifying them, we will have a fairer and better
system for our veterans. Second, it will facilitate effective and
efficient outpatient care for our Nation's veterans.
Mr. Speaker, the Committee on Veterans' Affairs has worked for years
to enact legislation that would achieve a comprehensive reform of VA
health care laws. H.R. 3118 is not the final answer, but it is a very
important first step. It does not remedy the serious funding challenges
that the VA has faced. It does not guarantee that every veteran will
get the care that they seek.
Comprehensive answers are beyond what we can accomplish in the few
remaining days of this session. Nevertheless, this legislation is a
bipartisan major step in the positive direction of serving our
veterans.
It is important legislation. This bill dismantles the statutory
barriers that have interfered with VA efforts to deliver appropriate
care. It simplifies an overly complex set of eligibility rules. It
expands veterans' access to routine outpatient care, to preventive
services and needed prosthetic supplies. And by providing greater
latitude for contracting, it gives the VA important new tools to manage
care delivery more effectively.
While this bill will help the VA to streamline its health care
delivery, it does provide very needed protection for some of the VA's
most unique and potentially vulnerable programs. At a time that the VA
must make every effort to reduce duplication and unnecessary
expenditures, veterans have urged us to be especially vigilant to
ensure that the VA maintains its vital specialized treatment and
rehabilitation programs.
The bill gives specific recognition to these programs and would
provide safeguards to ensure that the VA retains the capacity to serve
the specialized needs of the spinal cord injured, the blind, the
mentally ill, and other disabled veterans dependent on the VA's
specialized care programs.
Our efforts in this bill to help the VA expand veterans' access to
primary care services does not signal an intent to abandon needed
though sometimes costly specialized treatment missions.
Finally, Mr. Speaker, I want to add to the comments of other
colleagues on this floor. I want to add my deep and lasting gratitude
to the gentleman from Mississippi [Mr. Montgomery] for his many, many
years of service to his country, both in uniform and here as a Member
of Congress.
To the gentleman from Arizona, Mr. Stump, the partner with Mr.
Montgomery for so many years now in fighting for our Nation's veterans,
this legislation would not be on this floor without his leadership as
chairman of the committee.

{time} 1345

To the gentleman from Arkansas [Mr. Hutchinson], the subcommittee
chair who worked tirelessly with veterans service organizations and
Members of this House on both sides of the aisle to help bring this
bill to the floor, and finally and not least importantly I want to say
thanks to the gentleman from New York [Mr. Solomon], the chairman of
the Committee on Rules who helped see that this bill could come to the
floor in a timely fashion, knowing that there is not much time left in
this session of Congress and if we are to turn this from a bill into
law we must move quickly. So my thanks go out to Chairman Solomon for
his bringing this together.
Mr. Speaker, as with so much of the legislation for our Nation's
veterans heralded and pushed through this House by the gentleman from
Mississippi [Mr. Montgomery] and the gentleman from Arizona [Mr.
Stump], there is not a big fight on this floor today. There is not a
lot of people in the press gallery. Perhaps some think unless there is
a fight, it is not important legislation. But, Mr. Speaker, I would
suggest this is some of the most important legislation we have passed
on behalf of veterans for a long, long time, and it is a credit to the
leaders that I have mentioned in my last few comments that this is
coming to the floor on a bipartisan basis.
What a shame it is that the country does not see the headlines, the
articles, the news coverage when there is such a cooperative effort
made in this House of Representatives. But more important than the news
coverage is the fact that this legislation when passed into law will
make life better for our Nation's veterans who served all of us.
Mr. STUMP. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I thank the gentleman from Texas [Mr. Edwards] once
again for all of his work and for his very kind remarks on the floor
just now.
Mr. COLEMAN. Mr. Speaker, will the gentleman yield?
Mr. STUMP. I yield to the gentleman from Texas.
Mr. COLEMAN. Mr. Speaker, I only wanted to associate myself with the
remarks of my colleague from Texas. I think all of us, particularly
from that region of the country, as well as the gentleman from Arizona,
understand the importance of the statements made by my colleague from
Waco, TX, and I wanted to associate myself with his remarks, and I
thank the gentleman for yielding.
Mr. STUMP. Mr. Speaker, I yield 3 minutes to the distinguished
gentleman from New York [Mr. Solomon], chairman of the Committee on
Rules.
Mr. SOLOMON. Mr. Speaker, I cannot tell you how proud I am to stand
up here today as one of the sponsors of this critical veterans
legislation. I

[[Page H8773]]

commend the gentleman from Arizona [Mr. Stump], the gentleman from
Mississippi [Mr. Montgomery], the gentleman from Arkansas [Mr.
Hutchinson], and the gentleman from Texas [Mr. Edwards], and the entire
Committee on Veterans' Affairs for their hard work in bringing this
legislation to the floor.
Mr. Speaker, I served on that committee for 10 years. It was such a
pleasure because it was a committee of comity. Everybody worked
together for one common goal, and I commend my colleagues for it.
Mr. Speaker, VA eligibility reform has been a long, long time in the
making, and that is why it is such a relief for the veterans community
that we take this step here today. Ever since my days back in the
Committee on Veterans' Affairs and as a ranking member of that body,
alongside my good friend, the gentleman from Mississippi [Mr.
Montgomery], and the gentleman from Arizona [Mr. Stump], eligibility
reform has been one of our top priorities.
The reform bill we pass here today is a positive step in preserving
the future of the VA and veterans' health care. No matter how you look
at it Mr. Speaker, the fact remains that the veterans population is
dwindling. That means that it is up to us here today, those of us who
understand why it is absolutely critical that we protect the earned
contractual benefits of all of our veterans, to pass these protections
and to pass them into law.

H.R. 3118 I think is a great step toward streamlining health care
delivery within the veterans department. It will provide the basis for
constructing a system that will preserve the future of VA health care
and continue the all-important guarantee of health care for America's
deserving veterans, and that is something we have to guarantee down the
road for our all-voluntary military.
Mr. Speaker, I urge my fellow veterans and all Members of Congress to
pass this bill and finally put the process of reforming VA health care
underway. Americas veterans will thank you.
Mr. Speaker, in closing, let me heap praise on the former chairman of
this committee, Sonny Montgomery. As a veteran myself, I know I speak
for all of the veterans throughout this entire Nation in saying that we
are grateful for everything that the gentleman from Mississippi has
done all of these years. He is a great Congressman. He is a great
American and, more than that, he is a great friend of mine, and I wish
him the best in his retirement.
Mr. MONTGOMERY. Mr. Speaker, I yield myself 30 seconds.
Mr. Speaker, I apologize to the gentleman from New York for not
getting all of those remarks, but thank him very much. I want to point
out to my colleagues here today that the gentleman from New York, Mr.
Solomon, and I did work with him, but he was the leader that got the
Department of Veterans Affairs to be implemented and to become law, and
I would like to say on account of Jerry and others that the veterans
can go in the front door of the White House now where we used to have
to go in the back door. In fact, we had an administrator of the
veterans department that has to go through an individual in the White
House to see what needed to be done for veterans. And now we have the
Department of Veterans Affairs and Jesse Brown, who is a strong
Secretary and going a good job in my opinion.
I thank Chet Edwards for what he said about us.
Mr. Speaker, I yield 2 minutes to the gentleman from California [Mr.
Filner].
Mr. FILNER. Mr. Speaker, I thank the gentleman for yielding.
Mr. Speaker, H.R. 3118, The Veterans' Health Care Eligibility Reform
Act of 1966, is an important step toward improving health care for our
Nation's veterans.
The veterans in my congressional district, the leaders of San Diego
County's veterans community, and the representatives of national
veterans organizations all agree that we need veterans' health care
eligibility reform.
This bill will simplify the rules governing VA medical care. It will
allow veterans to get outpatient service when that is more appropriate
than inpatient care. This bill will allow the VA to treat veterans for
less money, with the savings going for expanded services.
Veterans' health care eligibility reform is one of the first issues
confronting me when I came to Congress in 1993, and I am proud to be a
member of the Veterans Affairs Committee which has worked so hard on
this bill.
I appreciate the work of Chairman Bob Stump, ranking member Sonny
Montgomery, chairman of the Subcommittee on Hospitals and Health Care
Tim Hutchinson, and Subcommittee ranking member Chet Edwards for their
tireless efforts in developing H.R. 3118.
As you know, similar legislation passed the Senate Veterans' Affairs
panel last week, which makes our vote today even more important. I urge
my colleagues to join me in support of this bill.
If this is indeed the last bill that Sonny Montgomery will be on the
floor for, we also want to add our profuse gratitude for his
friendship. I knew Sonny before any of you did, by the way. I worked
with him before he was a Member of Congress, when he was a general in
Mississippi. He taught us everything, and I think that the lasting, the
greatest legacy that Sonny Montgomery will have is that as much work as
he did, there is still more work to be done for veterans, and he has
trained us all, educated us all, and we will carry on the work that he
has been so successful at and we will finish the job that he started.
Mr. STUMP. Mr. Speaker, I yield 2 minutes to the gentleman from
Illinois [Mr. Weller], a member of the committee.
(Mr. WELLER asked and was given permission to revise and extend his
remarks.)
Mr. WELLER. Mr. Speaker, I come to the well today to speak on behalf
of this bipartisan bill, which will enable tens of thousands of rural
veterans to have greater access to VA outpatient health care. H.R. 3118
provides much-needed authority and allows the VA for the first time
ever to enter into sharing agreements with local health care providers
so that rural and suburban veterans can benefit from the convenience of
utilizing health care services in their local community, to be treated
by local doctors and local hospitals they know and trust.
For example, in my home district in LaSalle County, IL, the closest
outpatient center for veterans is 60 miles away. We have 45,000
veterans in the LaSalle County area. Sixty miles is a long way to
travel, and for many veterans it requires that they ask friends and
family to take off half a day or a full day just to provide
transportation.
This past spring, the gentleman from Arkansas [Mr. Hutchinson] and
the Subcommittee on Hospitals and Health Care held a field hearing in
LaSalle County and brought to light the need for some changes in VA
authority to be brought forward. Thanks to this hearing, we noted that
the VA is currently prohibited from contracting with private, nonprofit
health care providers.
This legislation, when passed into law, will not only benefit
counties like LaSalle in Illinois, but other rural care areas
throughout the Nation. This language was originally in H.R. 3321, a
bill I introduced to allow the VA to enter into contractual agreements
with local health care providers, doctors and hospitals in order to
provide health care to veterans locally.
Mr. Speaker, it just makes common sense to make it easier and more
convenient for veterans to have the opportunity to obtain veterans
health care right in their local community, right from their local
doctors, right from their local hospitals they know and trust.
I want to note that this legislation has broad-based support in the
veterans community; has broad-based bipartisan support amongst local
officials and members of this committee. I am proud that we are keeping
our commitment to our veterans and doing it in a bipartisan fashion.
Let us move forward and provide quality health care for our veterans
and meet our commitment to our veterans and give this bill bipartisan
support.
Mr. Speaker, I commend the chairman of the committee, the gentleman
from Arizona [Mr. Stump], and the ranking member for their efforts and
their bipartisan leadership.
Mr. MONTGOMERY. Mr. Speaker, I yield 2 minutes to the gentleman from

[[Page H8774]]

Massachusetts [Mr. Kennedy], who is also a member of the committee, one
of our ranking members.
Mr. KENNEDY of Massachusetts. Mr. Speaker, with everything I have to
say about the gentleman from Mississippi [Mr. Montgomery], maybe he
will want to make it 4 minutes. But let me just say very sincerely,
from really the bottom of my heart, how much I have appreciated all of
the hard work that Sonny Montgomery has shown.
I think particularly for some of the younger Members of Congress that
care very deeply about veterans issues there is no one that has stood
up more clearly and strongly on behalf of our Nation's veterans, no one
who commands the respect of Members of both sides of the aisle about
the issues of concern to our Nation's veterans than Sonny Montgomery,
and I know that Chairman Stump feels the same way.
We have all enjoyed, although not every moment that Chairman Stump
has had the gavel over the course of the last couple of years, I do not
think he has enjoyed a couple of moments that I have been speaking in
the last couple of years, but I do appreciate his sincere efforts on
behalf of Sonny Montgomery and to bring to the former chairman of the
committee, Mr. Montgomery, the credit that he deserves for the hard
work that he has done on behalf of our Nation's veterans.
Mr. Speaker, despite the fact that every other speaker has talked
about the fact that this is Sonny's last bill on the House floor,
unless he has some announcement, I hope he is going to be sticking with
us through next November. And I know that his spirit will continue to
guide us on veterans affairs far into the future.
Mr. Speaker, I join with Chairman Stump in thanking Sonny Montgomery
for all of the guidance, support, and courage that he has shown for our
country and for our Nation's veterans. I really appreciate it. In
addition, I also support this bill.
Mr. STUMP. Mr. Speaker, I yield 1 minute to the gentleman from
Illinois [Mr. Flanagan].
Mr. FLANAGAN. Mr. Speaker, I rise today in full support of H.R. 3118,
the veterans' eligibility reform bill, introduced by the gentleman from
Arizona [Mr. Stump] and the gentleman from Mississippi [Mr.
Montgomery].
And, parenthetically, Mr. Speaker, I have enjoyed every moment that
the gentleman from Arizona has had the gavel in his hand. And, Mr.
Speaker, I would say to Mr. Montgomery, our many great thanks, our many
great remarks at his leadership and the warmth that he has shown us
all, freshman Member and senior Member alike, over the years.
Mr. Speaker, I believe that this legislation, though not a complete
reform of current eligibility standards, is a positive first step
toward achieving that goal.
Veterans with service-connected disabilities, former POW's and World
War I veterans are eligible under this legislation.
H.R. 3118 will enable the VA to provide all needed hospital and
medical services to eligible veterans and expand operational
flexibility by enabling VA to contract for hospital care and medical
services to increase cost-effectiveness. It will also protect
specialized programs, and work to expedite VA's transition from
inpatient care to greater use of outpatient care efficiently and
effectively. This bill will accomplish these provisions without
reducing benefits to other veterans.
Mr. Speaker, we must never forget the sacrifices America's veterans
have made for our country and our freedoms. Quality and accessibility
of veterans' health care is a priority of this Congress. H.R. 3118
ensures that our veterans receive the very best in health care, and
reaffirms our commitment to our veterans. I am very proud to be a
cosponsor of H.R. 3118, as it will pave the way for greater reforms in
the future.
Mr. STUMP. Mr. Speaker, I yield 2 minutes to the gentleman from
Indiana [Mr. Buyer], chairman of the Subcommittee on Education,
Training and Employment.
Mr. BUYER. Mr. Speaker, I thank the gentleman from Arizona [Mr.
Stump], chairman of the Veterans' Affairs Committee, and the gentleman
from Mississippi, [Mr. Montgomery], our good friend, for their work on
this bill.
Mr. Speaker, this bill represents the culmination of years of hard
work on behalf of the most pressing issues facing the Department of
Veterans Affairs, that being eligibility reform. Anyone who has been to
a VA hospital knows how difficult it can be to access the VA health
care system. The patchwork of confusing and complex rules governing
accessibility often defy medical common sense.

{time} 1400

Madam Speaker, H.R. 3118 goes a long way to change this system while
staying within the current budget constraints. This bill requires the
VA to manage its medical services through a system of priorities,
giving service-connected veterans the top priority. We have some very
difficult issues that face us, that being the veterans' community, and
I want to thank Chairman Stump and Sonny Montgomery.
As we have a declining veteran population out there, with a
stabilizing VA medical system, this is a transition-type bill. I cannot
predict what the VA system is going to look like in year 2010 to 2015,
as we begin facing the reality of losing the World War II and Korean
veterans, which includes my father, but how we visualize that system
into the future is going to require some real leadership. This is a
transition bill. It is far from a perfect bill, but I am very pleased
with the hard work that the chairman has done. Appreciate it.
Mr. MONTGOMERY. Madam Speaker, I yield 1 minute to the gentleman from
North Carolina [Mr. Hefner].
Mr. HEFNER. Madam Speaker, first of all, I would like to say we are
certainly going to miss Sonny Montgomery around here. I served with him
for a lot of years, worked on a lot of veterans' legislation. He is to
be commended and he will be remembered a long, long time. As long as
veterans are around, he will be remembered.
Bob Stump, my dear friend from Arizona, who has worked very hard on
this bill and labored in the vineyard for so many years. I rise in very
strong support of this legislation and wish for Mr. Montgomery, as a
friend of mine in North Carolina often said, I hope you live as long as
you want and never want as long as you live, and rise in strong support
of this legislation which is long overdue.
I thank the gentleman from Arizona and the gentleman from Mississippi
for bringing it to fruition.
Mr. STUMP. Madam Speaker, I yield 2 minutes to the gentleman from
Oregon [Mr. Cooley].
Mr. COOLEY. Madam Speaker, I rise today in support of H.R. 3118, the
Veterans' Health Care Eligibility Reform Act of 1996.
I represent eastern Oregon, the seventh largest congressional
district in the country. Veterans in my district often must drive 4 or
5 hours--over the Cascades to Portland--in order to receive medical
care. Veterans who must drive so far for medical service have a strong
interest in fair and efficient eligibility standards.
By allowing the VA to contract out for hospital care and medical
services, and, by allowing the VA to share health care resources with
group providers, H.R. 3118 will potentially bring the VA closer to the
veterans of eastern Oregon.
H.R. 3118 also abolishes the complex provisions of law governing
eligibility for outpatient care, expanding the array of services that
the VA can provide to our Nation's veterans.
I urge all of my colleagues to support this long-overdue reform.
Madam Speaker, I, too, would like to thank the leadership, Sonny
Montgomery and his past services to the veterans of this country and,
especially now, the reins have been passed over to Bob Stump, and what
a fantastic job he has done to bring forth these issues which I think
are very, very critical, especially to our veterans more in the rural
areas that really truly have to drive many, many miles to receive this
kind of service.
I will tell my colleagues that in the near future I will probably be
using these as well. I would certainly like to be able to use the local
hospital instead of driving 155 miles to the closest veterans' hospital
for my community where I live in Alfalfa, OR. I think that the veterans
of the country and Congress should commend Bob Stump with the
cooperation of Sonny Montgomery

[[Page H8775]]

and the fantastic job they have done for veterans in this country. I
think we all are proud of both of these gentlemen.
Mr. STUMP. Madam Speaker, I yield 1 minute to the gentleman from
Florida [Mr. Weldon], a Member who has been very active in veterans'
affairs for his State.
(Mr. WELDON of Florida, asked and was given permission to revise and
extend his remarks.)
Mr. WELDON of Florida. Madam Speaker, I rise in strong support of the
bill before us.
As a veteran and a practicing physician, I understand firsthand the
needs of veterans in underserved areas. The veterans in east-central
Florida have suffered for over a decade and a half for lack of adequate
veterans medical facilities. Last year this Congress set us on a sound
road toward meeting these needs by providing $25 million to meet the
outpatient needs of these veterans.
H.R. 3118 includes provisions that will allow the VA to contract with
local hospitals to meet the inpatient needs of veterans who have
sacrificed for our great Nation.
Last year, I introduced legislation that would allow the VA to
contract in this manner. The bill before us includes similar provisions
and I appreciate the chairman for his support of this concept.
This bill will allow veterans in underserved areas, like east-central
Florida to receive VA medical care right in their own communities. This
is what veterans in my district have been telling me they want and I'm
pleased to see it before us.
Let's pass this bill.
Madam Speaker, I rise in strong support for H.R. 3118, the Veterans
Health Care Eligibility Reform Act. This bill is long overdue and it
will ensure that we fulfill our commitments to our veterans.
I would like to focus on one particular element of this bill that is
very important to the veterans in my district. It was more than 14
years ago that a veterans hospital was first proposed for east-central
Florida. Since that time, more politics has been played over this
hospital than one can recount. While politicians have enjoyed their
sport, the veterans in Brevard and surrounding counties have suffered
for lack of adequate veterans medical facilities.
Earlier this year the Congress took the right step by providing $25
million for an outpatient clinic. The VA has informed me that this
outpatient clinic will meet at least 80 percent of the health care
needs of area veterans. This is a good first step in meeting these
veteran's needs. I was also pleased that in a letter to me dated July
17, the Secretary of Veterans Affairs committed to issuing a contract
for design work by September 1996.
The verdict on a hospital for Brevard County is still out. There are
some who have suggested holding up the construction of a veterans
outpatient clinic and instead holding out for a full hospital. Anyone
remotely familiar with the history of the Brevard medical facility
recognizes that this would be playing Russian roulette with the lives
of veterans and would likely see the possibility of even an outpatient
clinic slip away.
Earlier this year the veterans of east-central Florida received an
authorization for a $25 million outpatient clinic, and Congress and the
President already set aside the $25 million needed to fully construct
this clinic. While an outpatient clinic may not meet 100 percent of the
needs, it will meet 80 percent of the needs and it will do so in less
than 2 years. Any delay in moving forward with this clinic may see this
money and clinic disappear like the hopes that these veterans have seen
fade away so many times before.
As a physician who has been put in the unfortunate position of having
to refer veterans across the State to a veterans hospital, I understand
how critical it is that veterans have access to inpatient care in our
own community. That is why I introduced H.R. 2798, the Veterans Health
Care Management and Contracting Flexibility Act of 1995. This bill will
allow the VA to enter into contracts with local hospitals to meet the
inpatient health care needs of area veterans. In other words, while the
verdict is still out on Brevard's VA hospital, veterans will be able to
receive inpatient care at local hospitals rather than being shipped
hours away from home and family. This in no way rules out the
possibility of a VA hospital in the future, but it ensures that
regardless of what happens, veterans will not continue to suffer for
lack of adequate facilities.
I am pleased that the provisions of my bill have been incorporated
into H.R. 3118. Quite frankly, broad contracting authority should have
been permitted years ago. It was wrong to allow veterans to suffer
while politicians played. The outpatient clinic and the inpatient
contracting will ensure that veterans in east-central Florida have
access to health care facilities. I will continue to work with veterans
throughout our community to ensure that their health care needs are
met.
I am pleased to be a part of our constructive effort to ensure that
we follow through on our promises to those who have given of themselves
to protect our liberty.
Mr. STUMP. Madam Speaker, I yield 1 minute to the gentleman from
Pennsylvania [Mr. Fox], a member of the committee.
Mr. FOX of Pennsylvania. Madam Speaker, I rise in strong support of
H.R. 3118, the Veterans' Health Care Eligibility Reform Act of 1996.
I would like to commend Chairman Stump, Ranking Member Montgomery,
Chairman Hutchinson, and Ranking Member Edwards for their joint
leadership on this important issue of health care eligibility reform.
This bill exemplifies the bipartisan tradition of the House Veterans'
Affairs Committee, on which I am proud to serve.
H.R. 3118 continues the efforts of this Congress in honoring our duty
to care for those who have risked their lives for our country. This
bill provides the comprehensive eligibility reform that has been needed
to clarify and correct current law which is complex, confusing, and
often inconsistent with sound health care practices. By authorizing and
clarifying eligibility without additional limitations, eliminating
inpatient restrictions on provision of prosthetic devices, and setting
sensible priorities for enrollment and registration, H.R. 3118
significantly improves current law.
I urge adoption of the bill and yield back the balance of my time.
Mr. MONTGOMERY. Madam Speaker, I thank my colleagues for their very
kind remarks today. I urge my colleagues to support this measure.
Madam Speaker, I yield back the balance of my time.
Mr. STUMP. Madam Speaker, I yield myself such time as I may consume.
Once again, as I mentioned, this may be the last time that the VA has
an opportunity to bring a bill to the floor of this House. I want to
take this opportunity to thank all the members of the committee for
their cooperation during this Congress.
Even on a committee that maintained a truly bipartisan work ethic,
there were still some scheduling inconveniences and problems that
Members were asked to endure and I appreciate very much all their
cooperation. I believe we have a good record of accomplishment to show
for this Congress.
Additionally, Madam Speaker, I would like to achkowledge the hard
work of our committee staff on both sides of the aisle. The bipartisan
tradition of this committee may start at the top but it is also
practiced by the staff in their work on all of our bills. We greatly
appreciate that. I want to thank them very much.
Mrs. KELLY. Mr. Speaker. I rise today in strong support of H.R. 3118,
the Veterans' Health Care Eligibility Reform Act. I am a cosponsor of
this legislation and urge all Members to support it.
One of the primary responsibilities of our Government is to provide
for those who have defended our freedoms. In attempting to meet this
responsibility, the Government has developed a complex, and often
confusing system of health care eligibility laws. The legislation
before the House today will help simplify the eligibility requirements
of veterans, thereby ensuring that needed hospital care and medical
services will continue to be provided to all veterans who are eligible
to receive it.
Mr. Speaker, the issue of veterans health care eligibility is one
that is very important to me. I have a particular interest in proposed
changes in the VA health care system because there are two VA medical
facilities located in the congressional district that I represent. That
is why I am supporting this legislation. H.R. 3118 will benefit the
thousands of veterans that use the two facilities in New York's 19th
Congressional District, and indeed will benefit all veterans around the
country who depend on the VA to meet their unique health care needs.
There are a few provisions of the bill that I would like to
highlight. First, H.R. 3118 will substitute the current single uniform
eligibility standard of eligibility with a new standard which is
clinically appropriate and based on a medically sound system of
priorities. The bill also extend indefinitely the VA's authority to
provide services to dependents of active-duty and retired service-
members. It clarifies the VA's authority to collect from insurance
plans of Department of Defense [DOD] beneficiaries cared for in VA
facilities to the same extent as

[[Page H8776]]

DOD currently recovers for care rendered in its facilities. Most
importantly, however, the bill authorizes the VA to retain these funds,
instead of being required to return them to the General Treasury. This
will provide the VA with additional resources for its use in continuing
to provide health care to veterans.
Mr. Speaker, it is vital that we continue to provide veterans with
the health benefits that they have earned. H.R. 3118 is one more step
that this Congress has taken to meet this responsibility. I would like
to thank Chairman Stump for his tireless leadership on veterans issues
and for bringing this measure to the floor, and I would urge all
Members to lend H.R. 3118 their support. Thank you.
Mr. HASTERT. Mr. Speaker, I rise today to support a measure that will
help provide veterans in Illinois' LaSalle County with outpatient VA
services.
LaSalle County veterans have had to travel long distances to receive
needed VA medical services. This often requires a family member or
friend to travel with or drive them to their appointments. The Veterans
Health Care Eligibility Reform Act, will help provide an outpatient VA
clinic in LaSalle County which will serve over 13,000 eligible veterans
and their families.
At a veterans field hearing this past April, Representatives Tim
Hutchinson, Jerry Weller, Lane Evans, and myself heard the concerns of
representatives of several organizations who testified to the need for
a closer outpatient care center. The nearest outpatient care facility
for eligible LaSalle County veterans is over an hour's drive away, with
the nearest VA hospital over 2 hours away.
The measure adopted today authorizes the VA to provide all needed
outpatient care services, including preventive care and home health
care, and to contract out for those services where a VA facility does
not exist.
This important legislation represents the commitment of Veterans'
Committee chairman, Bob Stump, the entire House Veterans' Committee,
and this Congress to keep our promises to our Nation's veterans.
Our veterans answered the call when our Nation needed them, so
Congress must answer the call when veterans need our help. Today, we've
answered that call and I'm proud to support this measure.
Mr. STEARNS. Mr. Speaker, I rise in support of this legislation today
which takes the first step toward comprehensive veterans' health care
reform. Passage of this bill will ensure changes in the tricky
eligibility rules that currently bar access to health care for our
Nation's veterans.
The health care eligibility bill accelerates the shift from expensive
inpatient care to more cost effective primary and outpatient care. The
reform is necessary to ensure that the VA refocuses its efforts toward
assisting those who served our country. Under current VA rules,
veterans are required to check into hospitals to receive their intended
treatment. The savings alone from this switch to outpatient care
services will allow more veterans to have access to the health care
system.
The legislation continues the path of decentralization and
restructures the VA with regard to the management of its health care
system. By increasing the number of VA partnerships with community
providers, access to outpatient services, and protecting the VA's
special disability programs, H.R. 3118 will be a major step in the
right direction for veterans' health care reform.
I want to emphasize that this measure is only the first step toward
achieving health care reform for our veterans. It is imperative that we
meet this challenge and preserve health care for those who have given
selflessly to serve our country.
Mr. BILIRAKIS. Mr. Speaker, I rise in support of H.R. 3118, the
Veterans' Health Care Eligibility Act. I ask unanimous consent to
revise and extend my remarks.
Eligiblity reform is an issue that the Veterans' Affairs Committee,
the VA and veterans service organizations have been working on for a
long time. I am a cosponsor of the Veterans' Health Care Eligibility
Reform Act and am pleased that we are moving this important bill
forward through the legislative process.
Today's complex and confusing eligibility criteria represent a
continuing source of frustration for both veterans and VA personnel.
Moreover, it is often an impediment to providing veterans with the kind
of health care they really need.
As most health care providers move toward a new model of care that
emphasizes primary and preventive care in outpatient settings, the VA
must also shift its focus from inpatient to outpatient care. Without
meaningful eligibility reform, it will be extremely difficult for the
VA to remain a viable health care provider.
H.R. 3118 is a step in the right direction for the VA and simplifying
the VA's eligibility criteria will greatly benefit veterans.
H.R. 3118 will expand veterans' access to VA care, particularly for
those with service-connected disabilities or limited means. It will
eliminate statutory rules which for years have barred the VA from
providing many veterans with routine outpatient treatment, preventive
health care services and home care.
Eligibility reform is long overdue and I urge my colleagues to
support H.R. 3118.
Mr. EVERETT. Mr. Speaker I rise today to indicate my strong support
for H.R. 3118 offered by VA Committee Chairman Stump and our ranking
member, Sonny Montgomery.
Mr. Speaker, this important legislation is a giant first step in
improving access to and the quality of health care provided to our
veterans. To our many veterans who served in our Armed Forces, who
loyally and selflessly gave a portion of their lives and the lives of
their families to protect and defend this country, we owe a debt that
can never be fully repaid.
Mr. Speaker, we have a responsibility to meet the health care needs
of these veterans. H.R. 3118 will enable the VA to restructure and
prioritize health care delivery and eligibility criteria. Rather than
continuing to focus on inpatient care, which is not only more expensive
but is, in most cases, less desirable for the patient, the VA will have
the flexibility to expand access to outpatient treatment and
preventative services.
Mr. Speaker, this element of the bill is especially important for my
constituents. I represent a majority rural part of southeast Alabama.
Over 37,000 veterans reside within a 50-mile radius of the city of
Dothan, AL. These veterans, whether ill, elderly, disabled, or infirmed
must travel over 100 miles, even 200 miles, to reach a VA medical
facility. For many, they may wait until their injury or illness has
reached a dangerous point before they make the trip.
Mr. Speaker, for years I have worked with the VA to establish an
outpatient access point around the Dothan area. Certainly, this
legislation reinforces the priority for such a facility. Quality
outpatient care, preventative health care services, and reliable home
care should be readily available and accessible to our eligible
veterans' population. To this end, we must foster relationships with
our community health care providers and in turn provide more
opportunities to meet the needs of our veterans with expanded
ambulatory treatment services.
Mr. Speaker, H.R. 3118 goes a long way to meet these goals. Yes, this
legislation is a first step, but a giant step in the right direction. I
urge my colleagues to offer their unbridled support for H.R. 3118.
Mr. STUMP. Madam Speaker, I have no further requests for time, and I
yield back the balance of my time.
The SPEAKER pro tempore (Mrs. Myrick). The question is on the motion
offered by the gentleman from Arizona [Mr. Stump] that the House
suspend the rules and pass the bill, H.R. 3118, as amended.
The question was taken.
Mr. SOLOMON. Madam Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 5 of rule I and the
Chair's prior announcement, further proceedings on this motion will be
postponed until disposition of H.R. 2391.

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